“Inflammatory peritonitis in a child with COVID-19″

Abstract

COVID–19 is the disease caused by SARS-COV-2 coronavirus infection (Severe acute respiratory syndrome coronavirus 2). Although its most prevalent symptoms are respiratory, there are descriptions of gastrointestinal manifestations in children, but the presentation as an acute abdomen is rare. We report the case of a 6-month-old infant who was admitted with a diagnosis of intestinal obstruction and generalized peritonitis with no apparent cause, in whom a SARS-CoV-2 rt-PCR search was positive. We have not found descriptions of similar cases in the literature so far.

Emergency diagnostic laparoscopy for multisystem inflammatory syndrome in a child

“…The presented case allowed us to suggest that the early evacuation of the exudate by laparoscopy (<12 hours from the “acute abdomen”/peritonitis symptoms onset) interrupts, without the use of steroids and intravenous immunoglobulins, the vicious blockchain, when the inflammatory cytokines contained in the peritoneal exudate cause inflammatory (sometimes micro-necrotizing) changes in the abdominal organs, making them permeable for intestinal microorganisms, which, as a result, can cause purulent peritonitis and inflammatory-septic shock. Early laparoscopy should, at least, be a therapeutic and possible prophylactic procedure for purulent peritonitis with “thick fibrinous-purulent ascites diffusely adjacent to the abdominal organs” [ 9 ], which is rare, but, unfortunately, occurs in children with COVID-19. One case, albeit successful, does not give full confidence concerning the need for extensive use of laparoscopic or another minimally invasive method – ultrasound-guided laparocentesis for early evacuation of cytokine-toxic peritoneal exudate in patients with similar clinical profiles.…”

“…Multisystem inflammatory syndrome in children can mimic [ 1 , 2 ] and/or provoke acute abdominal diseases: intestinal intussusception/obstruction [ 3 ], terminal ileitis and/or colitis [ 4 ], internal hernia, necrotizing mesenteric lymphadenitis, acute appendicitis [ [5] , [6] , [7] ]and intestinal perforation [ 8 ], which can lead to a life-threatening condition called “inflammatory peritonitis” [ 9 ] and, as a result, an inflammatory syndrome that resembles septic shock, or, in some cases, septic shock itself (see Fig. 1 ).…”

Manajemen Anestesi Peritonitis Eksplorasi pada Anak Usia 5 Tahun

“…Keluhan yang dirasakan pasien dapat berupa onset gejala yang akut, penyakit yang terbatas dan ringan atau penyakit sistemik dan berat dengan syok septik. Infeksi peritoneal diklasifikasikan sebagai primer (yaitu, dari penyebaran hematogen, biasanya dalam pengaturan immunocompromise), sekunder (yaitu, terkait dengan proses patologis pada organ visceral, seperti perforasi, trauma, atau pasca operasi), atau tersier (yaitu, infeksi persisten atau berulang setelah terapi awal yang memadai) (Takegawa et al, 2021).…”